Provider Demographics
NPI:1790376945
Name:HEALTHY MD CLINICAL, LLC F/K/A INDEPENDENT MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:HEALTHY MD CLINICAL, LLC F/K/A INDEPENDENT MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIXAMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-773-7066
Mailing Address - Street 1:6119 LYONS RD
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4740
Mailing Address - Country:US
Mailing Address - Phone:800-773-7066
Mailing Address - Fax:833-258-4230
Practice Address - Street 1:28420 BONITA CROSSINGS BLVD SUITE 130
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135
Practice Address - Country:US
Practice Address - Phone:407-314-7492
Practice Address - Fax:833-258-4230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHY MD CLINICAL, LLC F/K/A INDEPENDENT MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-31
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service